Researchers develop new tool to predict who will use microbicides

Using a new tool designed to measure a woman’s willingness to use a microbicide (topical gels designed to prevent the sexual transmission of HIV), researchers at The Miriam Hospital and Brown University found that women who have used protective methods in the past, and those with casual sexual partners were more willing to use a microbicide compared to their peers.

Although a safe and effective microbicide has not been identified yet, several candidates are now undergoing clinical efficacy trials. The complete study is published in the November 2007 issue of Healthy Psychology.

“The results may seem to be an obvious finding, but they are important because science has very little direct evidence of what characteristics and situations in women’s lives would make them more likely to want to use a microbicide to prevent HIV infection,” says lead author Kathleen M. Morrow, Ph.D., a psychologist at The Miriam Hospital’s Centers for Behavioral and Preventive Medicine and an assistant professor at The Warren Alpert Medical School at Brown University.

“An effective microbicide would have little impact on the rate of HIV transmission if it was unacceptable to women, i.e. – if it makes their sexual experiences less pleasurable, or gets in the way, women won’t use it, no matter how effective it is” says Morrow.

In an attempt to understand the circumstances that compel women to decide to protect themselves or not, Morrow and her team designed the “Willingness to Use Microbicides” scale. The scale consists of a series of questions about particular situations, e.g. – would you have wanted to use a microbicide the last time you had sex with your partner, as well as product-related questions, e.g. – if a microbicide costs about as much as a male condom, would you have used it?

The questionnaire was given to 531 women in Connecticut, Massachusetts, New York, and Rhode Island. Eligibility criteria required that the women be 18-55 years old, HIV-negative or of unknown HIV status, not pregnant, and having had sex with at least one male partner in the last year.

The researchers evaluated each participant’s answers to the questions in relation to a number of variables including the participant’s race/ethnicity, household income, number of partners, partner type, if the participant had lived with the partner in the past year, participant’s perception of her partner’s behaviors that put him at risk for HIV, frequency of condom use, and history of spermicide use.

The results suggested that women with a greater frequency of condom use, a history of spermicide use, and those with casual sexual partners (as opposed to main partners), had the highest predicted scores on the “willingness to use” scale.

“Our findings indicate that not only how much experience a woman has with prevention products can have predictive implications, but additionally – how a woman defines or labels her sexual partnership appears to have an impact on her decision-making process with regard to protecting herself from HIV and other sexually transmitted diseases (STDs),” says Morrow.

The authors note that there is often a perceived need for less protection in an established relationship and a greater need for protection in more casual relationships. This is particularly important because, globally, the majority of women with HIV get it from their sole male sexual partner, typically their husband.

Morrow adds, “If a woman does not perceive the risk, she won’t protect herself. Our results underlie the importance of educating all women, even those in committed relationships, about preventive measures they can take.”

"Given the rise in the number of women becoming infected with HIV annually around the world and the limited ability of many women to insist upon condom use with their male sexual partners, the need for woman-initiated HIV prevention options is profound,” says Kenneth Mayer, M.D., an infectious disease specialist at The Miriam Hospital and a professor at The Warren Alpert Medical School of Brown University who has led several clinical microbicide studies.

“The Willingness to Use Microbicides Scale serves as an important step toward understanding and measuring a woman's decision-making process for protection against STDs and HIV,” Mayer adds.

The researchers explain that future research should allow for the further refinement of the scale including the exploration of additional variables and situations that could impact a woman’s “willingness to use” score.

“In addition, the scale needs to be applied to a more diverse population of women, both within the United States and in other countries to determine if sociogeographic factors have an impact on a woman’s willingness to use,” adds Morrow.

The researchers are continuing to study women’s opinions about vaginal products like microbicides, and are currently conducting a related study, Project LINK. The study aims to investigate women’s perceptions of how vaginal products feel in their bodies and what product developers can do to make HIV prevention products feel good so women would find them acceptable to use. If you are a woman, 18-45 years old, and would like additional information about Project LINK, call 1-888-355-LINK(5465).

Source: Lifespan

Related stories:

Vaginal microbicides may prevent more infections in men than women
Vaginal microbicides currently in clinical trials may be the only weapon that will protect women against infection from HIV. Yet, under likely circumstances, these microbicides may be of more benefit to men than women, according to a new UCLA AIDS Institute study.
Anti-HIV gel proven safe, tolerable for women
An experimental anti-HIV gel is safe for women to use on a daily basis, according to researchers at the University of Alabama at Birmingham (UAB) and the University of Pittsburgh School of Medicine.
Semen ingredient 'drastically' enhances HIV infection
A plentiful ingredient found in human semen drastically enhances the ability of the human immunodeficiency virus (HIV) to cause infection, according to a report in the December 14, 2007, issue of the journal Cell, a publication of Cell Press. The findings help to understand the sexual transmission of HIV and suggest a potential new target for preventing the spread of AIDS, the researchers said.
A molecular condom against AIDS
University of Utah scientists designed a "molecular condom" women could use daily to prevent AIDS by vaginally inserting a liquid that would turn into a gel-like coating and then, when exposed to semen, return to liquid form and release an antiviral drug.
UCSF study will test new vaginal microbicide for herpes and HIV
A team of researchers at UCSF is seeking young women to participate in the first US study of the safety of a new a vaginal gel designed to prevent herpes and HIV infection. If it is effective and approved by the U.S. Food and Drug Administration, the gel would be an important weapon in the fight against HIV because it would allow women to protect themselves from infection rather than relying on their partners to use condoms.
Study defines effective microbicide design for HIV/AIDS prevention
Duke University biomedical engineers have developed a computer tool they say could lead to improvements in topical microbicides being developed for women to use to prevent infection by the virus that causes AIDS.
Psychosocial issues affect HIV/AIDS treatment outcomes
Psychosocial influences such as stress, depression and trauma have been neglected in biomedical and treatment studies involving people infected with HIV, yet they are now known to have significant health impacts on such individuals and the spread of AIDS, according to a University of North Carolina at Chapel Hill scientist.
Radical reform is needed to stop the 'inhumane' practice of transplant tourism
The UK government must bring in presumed consent to organ donation or allow a controlled donor compensation programme for unrelated live donors, in order to bring the "inhumane" practice of transplant tourism from the UK to an end, claims a doctor in this week's BMJ.

News discussion:

Medicine & Health news